SAN FRANCISCO—Treatment practices often vary in the United States between physicians and across geographic regions, and such variation may be more likely when definitive comparisons of treatment modalities are lacking, as is the case with the management of early laryngeal carcinoma.
Now, a survey of otolaryngologists suggests that such differences in the treatment of early laryngeal cancer may stem primarily from the physician’s age and training, with the more recently trained physicians more likely to leave the treatment choice up to the patient.
Laurence DiNardo, MD, assistant professor of otolaryngology, Medical College of Virginia, Richmond, and his colleagues sent questionnaires to 3,000 randomly selected American Academy of Otolaryngology-Head and Neck Surgery members around the country; 1,000 of 1,029 re-plies were complete enough to be included in a statistical evaluation using multivariable frequency analysis.
Dr. DiNardo reported the results at the 101st Annual Meeting of the American Academy of Otolaryngology-Head and Neck Surgery. For patients with operable supraglottic tumors, he said, 41.6% of the respondents recommended supra-glottic laryngectomy. Radiation therapy was advocated by 5.3%, and total laryngectomy by 1.4%.
The largest group of respondents, 48.3%, said they typically explain treatment options to the patient and leave the ultimate decision in the patient’s hands.
Results were similar for glottic tumors: Hemilaryngectomy was recommended by 37.1% of responding physicians, radiation therapy by 8.1%, and total laryngec-tomy by 1.9%, while 50.4% left the final choice up to the patient.
When the treatment choice was left up to the patient after a discussion of the options, the choice was much less likely to be surgery than when surgery was advocated by the treating physician.
Factors Affecting Treatment
A number of regional and practice setting trends were seen in the study, although none correlated strongly with physician recommendations. Physicians in the Southwest and Midwest were most likely to advocate definitive therapy. Physicians in the Northeast and Northwest tended to rely more heavily on patient choice, Dr. DiNardo said.
He added that the physicians’ ratings of available radiation oncology services weighed heavily in their final treatment recommendations.
The date of completion of residency training was one of the primary factors affecting treatment recommendations. Younger, more recently trained physicians were much more likely to rely on patient choice in selecting treatment than were their older colleagues.
In the future, Dr. DiNardo said, patient choice and cost considerations are likely to have the greatest impact on the treatment of early laryngeal cancers.
